Experts Discuss Psoriasis

According to the National Psoriasis Foundation, psoriasis is the most commonly diagnosed autoimmune disease, affecting 7.5 million Americans and 125 million people worldwide. The skin disease is associated with other potentially serious conditions, such as diabetes, heart disease, and psoriatic arthritis.

We talked with 2 leading dermatologists to learn more about the disease.

Dr. Lowell Goldsmith is Dean Emeritus of the University of Rochester School of Medicine and Dentistry and Professor of Dermatology at the University of North Carolina. Dr. Goldsmith is one of the Masters of Dermatology in the American Academy of Dermatology and has served as President of the Association of Professors of Dermatology, Society for Investigative Dermatology, and the American Dermatology Association.

Dr. Jeff Bernhard is a practicing dermatologist and Editor Emeritus of the Journal of the American Academy of Dermatology and Professor of Medicine and Physiology Emeritus at the University of Massachusetts Medical School, where he was Chief of Dermatology for nearly 2 decades. He is a section editor for the British Journal of Dermatology and a member of the editorial boards of the Journal of the European Academy of Dermatology and Venereology and the International Journal of Dermatology.

What is psoriasis?
Dr. Goldsmith: Psoriasis is a disorder with a strong genetic basis. It frequently starts in late childhood or adolescence, though it may occur at any age.
Dr. Bernhard: Psoriasis is an inflammatory disease of the skin presenting as pink, scaling plaques anywhere on the body, but it usually occurs in areas such as the elbows, knees, and scalp.

What causes psoriasis rash?
Dr. Goldsmith: Psoriasis results when the immune system is hyperactive, causing the outer layers of the skin to grow and proliferate. In some people, psoriasis is triggered by a streptococcal growth or skin infection. Early treatment intervention of those infections is really important.
Dr. Bernhard: The disease starts with the infiltration of inflammatory chemical mediators and cells that cause the epidermis to proliferate more quickly than normal. This leads to an inability of the cells to mature as they rise from the basal layer of the skin to the outer surface layer, or stratum corneum. The cells that should be shed accumulate to form red or pink, scaly lesions, typically known as psoriatic plaques.
 
How can I tell if my rash is psoriasis?
Dr. Goldsmith: The psoriasis rash is a scaly red or pink patch affecting small (dime-size) to larger areas (several inches in diameter). It can occur anywhere on the body, though it is common in areas of pressure, such as the knees and elbows, belly button, and the area between the buttocks. It can also cause thick scaling on the scalp. Psoriasis can actually cover the entire body and may also affect the nails. Your physician will recognize psoriasis because of its characteristic patterns with sharp borders. Psoriasis is very different from the dry, scaly skin with diffuse borders that affects many people during the winter.
Dr. Bernhard: If you experience scaly, red plaques on the scalp, elbows, knees, or buttocks, it is best to consult your dermatologist or personal physician to determine if your rash is psoriasis, especially if you have a family history of the disease.

How can I get rid of the scaly skin and rash from psoriasis?
Dr. Bernhard: There are many different treatments for psoriasis, so consult with your physician to determine the best treatment for your condition. Your doctor will evaluate how severe the rash is, how extensive it is, and how much it interferes with activities of daily living. Treatments include simple creams and ointments, such as corticosteroid creams or ointments, vitamin D analog creams or ointments, and oral medication with agents such as methotrexate. There is also a new category of so-called biological drugs (such as adalimumab and etanercept) that are injected or given by IV infusion.

What will my doctor prescribe for psoriasis?
Dr. Goldsmith: Your doctor may prescribe from a number of preparations, including topically applied corticosteroids of various strengths; a vitamin D medicine called calcipotriene; a vitamin A oral retinoid such as acitretin; and a variety of internal and higher-dose systemic medicines for more severe cases such as methotrexate. Recently, a new class of biologic medicines has been developed, made from proteins produced by living cells rather than chemicals. These medicines interfere with the immune system processes that cause the overproduction of skin cells and inflammation.
Dr. Bernhard: Treatment depends on severity, whether or not there are associated symptoms or involvement of other organs like the joints, and how much interference there is with daily life and other activities, including work and intimate relationships. Because psoriasis is recognized as a disease that often involves more than just the skin, appropriate treatment is important. For example, psoriatic arthritis affects not only the skin but the joints as well. And psoriasis may also be associated with so-called metabolic syndrome, involving high triglycerides and hypertension. Frequently, obesity is associated with psoriasis, which may also impact treatment options.

Psoriasis is a serious condition that can have lifelong impact on the individuals who suffer from it. To learn more about psoriasis or to see additional images, visit our psoriasis page.

Join us next month as we continue to bring you information and excerpts from our discussion with Drs. Goldsmith and Bernhard about skin rashes, and look for ongoing Q&A posts with our experts on this topic.